Elsevier

The Journal of Pediatrics

Volume 141, Issue 5, November 2002, Pages 652-658
The Journal of Pediatrics

Original Articles
Development of airway function in infancy after preterm delivery,☆☆

Presented in part at the European Respiratory Society Conference, Berlin, Germany, September 22-26, 2001.
https://doi.org/10.1067/mpd.2002.128114Get rights and content

Abstract

Objective: To assess airway function at 1 year and compare this with similar measurements made shortly after birth in preterm infants without clinical neonatal respiratory disease. Study design: Infants born at ≤36 weeks' gestational age were eligible if they required no neonatal ventilatory support and were otherwise healthy. Paired measurements of maximal expiratory flow at functional residual capacity (V′maxFRC) were obtained ~3 weeks after birth in 24 preterm infants (gestational age [mean ± SD], 33.2 ± 2.2 weeks) and repeated at a corrected postnatal age (mean ± SD) of 57.0 ± 12.2 weeks. V′maxFRC values were expressed as Z scores by means of sex-specific prediction equations. Results: V′maxFRC was within normal range for all infants shortly after birth (mean ± SD Z score: −0.06 ± 0.92). By 1 year, Z scores had reduced significantly [mean (95% CI) 2nd-1st test: −1.94 (−2.27, −1.60)]. V′maxFRC Z scores at 3 weeks were highly correlated with those at 1 year of age (Spearman correlation coefficient 0.64). Conclusions: Airway function during the first year shows considerable tracking. Even in the absence of neonatal respiratory disease, preterm delivery is associated with altered airway development during early infancy. (J Pediatr 2002;141:652-8)

Section snippets

Study population

Preterm infants were eligible for recruitment from the Neonatal Unit at the Homerton Hospital, London, if they were born at ≤36 completed weeks' gestation and required minimal ventilatory assistance (defined as intubation for <6 hours after delivery and/or supplemental oxygen for <24 hours). Infants were ineligible for recruitment if they had had any respiratory problems, including upper or lower respiratory illnesses before the first respiratory test or had coexistent congenital abnormalities.

Results

Forty infants born in the final year of the original study were recontacted, and 26 (65%) of these infants returned for respiratory function tests at approximately 1 year. Failure to follow up was primarily the result of the family moving from the district or parental concern regarding the need for sedation for tests. V′maxFRC measurements at follow-up were unsuccessful in 2 infants because of technically unacceptable partial flow-volume curves or the child waking before data collection was

Discussion

Despite apparently normal values during the neonatal period, V′maxFRC is significantly diminished at 1 year of age in preterm infants who have not had any neonatal respiratory problems. In addition, among this group of infants, V′maxFRC values at 1 year are highly correlated with values obtained at 3 weeks of age, suggesting considerable tracking of airway function during the first year of life.

Although small, our study sample is representative of the original cohort. Subjects were selected on

Acknowledgements

We thank the parents who allowed their infants to take part in this study and staff of the Special Care Baby Unit, Homerton Hospital, for their support. We are grateful to Professor Tim Cole, Centre for Paediatric Epidemiology and Biostatistics, for statistical advice, and Dr Colin Feyerabend at ABS Laboratories, Medical Toxicology Unit, London, for cotinine analyses.

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    Supported by the Foundation for the Study of Infant Death, the Dunhill Medical Trust, the Deutsche Forschungsgemeinschaft, and Portex Plc. Research at the Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust benefits from R & D funding received from the NHS Executive.

    ☆☆

    Reprint requests: Ah-Fong Hoo, MPhil, Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street Hospital NHS Trust, 30 Guilford St, London WC1N 1EH, United Kingdom.

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